CNA forgot to take patient off bedpan for 4 hours and now patient has wounds

[rork17]

Title pretty much says it all. A cna left a patient on the bedpan for 4 hours and now the patient has 3 open areas on their buttock. Obviously it is documented, assessed yadda yadda. This is a good cna how much trouble do you think they will get into? I havent had a situation like this before.

[kp2016]

Totally depends on your manager. Anywhere from a written warning to fired for patient neglect. How angry the family is may be a factor as well.

If they upset but understanding it’s more likely to be a warning. If they are furious and out for blood being fired is more likely.

[Hoosier_RN, MSN]

The nurse can be held responsible as well, sadly, as we are responsible for all that unlicensed personnel perform under us. I've seen a nurse and CNA terminated for exactly this

[inthecosmos, BSN, MSN, RN, APRN]

Several people dropped the ball on this one. Bed sores are costly and usually fall on the facility to pay for. Nothing could happen or both the nurse and the CNA could be fired.

[kbrn2002, ADN, RN]

A good CNA with an otherwise clean record will probable be OK as far as keeping their job unless the family is upset and out for blood. If so then it's not just the CNA in danger of losing their job but possibly the nurse as well.

[Kooky Korky, BSN, RN]

On 8/9/2019 at 9:13 AM, Hoosier_RN said:

The nurse can be held responsible as well, sadly, as we are responsible for all that unlicensed personnel perform under us. I've seen a nurse and CNA terminated for exactly this

I don't really see why the nurse should be held responsible.

What are the legalities in this sort of scenario? If the nurse knew about it but did nothing, I could see the nurse being liable. But if the nurse didn't know, if the nurse had a ton of work for which she was responsible (meds, charting, other nurse duties - things the nurse cannot delegate), how can the nurse be held liable? I'm not saying you are wrong, I just see it somewhat differently. I wonder how the Board views it?

If the nurse is responsible, the DON, CNE, ADON, all those responsible for training and supervision of staff should also be leable.

On 8/10/2019 at 1:03 AM, inthecosmos said:

Several people dropped the ball on this one. Bed sores are costly and usually fall on the facility to pay for. Nothing could happen or both the nurse and the CNA could be fired.

Who dropped the ball?

[Hoosier_RN, MSN]

1 hour ago, Kooky Korky said:

I don't really see why the nurse should be held responsible.

What are the legalities in this sort of scenario? If the nurse knew about it but did nothing, I could see the nurse being liable. But if the nurse didn't know, if the nurse had a ton of work for which she was responsible (meds, charting, other nurse duties - things the nurse cannot delegate), how can the nurse be held liable? I'm not saying you are wrong, I just see it somewhat differently. I wonder how the Board views it?

If the nurse is responsible, the DON, CNE, ADON, all those responsible for training and supervision of staff should also be leable.

Who dropped the ball?

nurses are responsible for the CNAs that work under us, I guess it depends on how far the facility and family want to press it. We are responsible for that which we delegate, no matter how busy we are. The facility that I worked at back then took it to the core, and were within their rights to do so. The nurse got a lawyer who is well versed in this, and she told her it is unfortunately true. The facility, nurse, and CNA were sued and it was settled out of court. The nurse was fired and blacklisted in our small community, and she has since moved, I don't know what she does now. The CNA works at another facility in the community at this time, but from what I understand, is way more careful

[JKL33]

12 hours ago, Hoosier_RN said:

We are responsible for that which we delegate, no matter how busy we are. The facility that I worked at back then took it to the core, and were within their rights to do so.

I agree with you but at this point would love to see this successfully challenged. There is nothing about the way things are run currently that makes nursing assistants' duties delegated in practical application (except in those scenarios where they are indeed asked by the responsible RN to perform an individual task). They receive their duties and workflow from the employer directly. In some places they can perform even invasive procedures by protocol, and if there are performance concerns RNs are basically told to stay in their own lane. This is not delegation in away or shape, other than delegation from the employer/supervisor directly.

I don't support this at all. It is a perversion of the idea that their tasks are supposedly legally being delegated by the patient's RN.

[humerusRN, BSN]

IMO, 4 hours without the RN rounding is inexcusable and definitely would be grounds for disciplinary action for the RN (and the CNA).

[Hoosier_RN, MSN]

22 hours ago, JKL33 said:

I agree with you but at this point would love to see this successfully challenged. There is nothing about the way things are run currently that makes nursing assistants' duties delegated in practical application (except in those scenarios where they are indeed asked by the responsible RN to perform an individual task). They receive their duties and workflow from the employer directly. In some places they can perform even invasive procedures by protocol, and if there are performance concerns RNs are basically told to stay in their own lane. This is not delegation in away or shape, other than delegation from the employer/supervisor directly.

I don't support this at all. It is a perversion of the idea that their tasks are supposedly legally being delegated by the patient's RN.

16 hours ago, humerusRN said:

IMO, 4 hours without the RN rounding is inexcusable and definitely would be grounds for disciplinary action for the RN (and the CNA).

I agree with both, but it's the nature of healthcare anymore. Those at the bedside get hung out to dry-nurses and UAP. JKL33 stated that the tasks come from the employer, true, but in nursing school we are taught that they are delegatable task, as nurses we can do then ourselves as well as UAP. This is where the issues come in. Short staffing becomes the icing on the cake

[kbrn2002, ADN, RN]

21 hours ago, humerusRN said:

IMO, 4 hours without the RN rounding is inexcusable and definitely would be grounds for disciplinary action for the RN (and the CNA).

Maybe so, maybe not. Have you ever worked in a LTC facility? Odds are if a resident was left on a bed pan for 4 hours it was on a night shift. That nurse could easily be responsible for 50+ residents. Physical rounding by the nurse at that point means just putting eyeballs on the residents to make sure they are safe in bed and still breathing unless there is a compelling reason to do a more in depth check. Actually pulling back blankets and disturbing a sleeping resident just to see if maybe they were left on a bedpan isn't likely to happen.

Now for a CNA to not do rounds every two hours is not OK at all. Though there are independent residents that do not require every two hour rounding, if the CNA in question forgot she [or he] gave one of those residents a bedpan I could see this happening. On the other hand, if this resident were truly independent enough to not require scheduled two hour rounds they should also be independent enough to ring for assist when they were done using the bedpan. At the very least the care plan should be updated for this resident as they are obviously no longer fully independent with their toileting requests.

[Nurse SMS, MSN, RN]

Infuriating. If that were my mother, you can bet I would be livid. How on earth does that even happen?